NPIMap

Organization Active NPI

Cancer Care Associates Medical Group Inc

  • Hematology & Oncology Physician
  • San Pedro, CA
National Provider Identifier
1942299839
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
FNP17913 Issued in CA
Legal business name
CANCER CARE ASSOCIATES MEDICAL GROUP INC
Practice address
1360 W 6TH St
Ste #315
San Pedro, CA 90732-3581
Phone
(310) 750-3300
Fax
(310) 750-3381
NPI assigned
Oct 14, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Chan, MDNPI 1972591378
Title
Co Owner President
Phone
(310) 750-3300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X FNP17913 CA Primary

Addresses

Primary practice location

1360 W 6TH St
Ste #315
San Pedro, CA 90732-3581

Mailing address

514 N Prospect Ave
4TH Floor
Redondo Beach, CA 90277-3040
Phone (310) 750-3300

Other identifiers 2

IdentifierTypeStateIssuer
CS0850OtherRAILROAD MEDICARE
ZZZ28793ZOtherBLUE SHIELD

National Provider Directory

National Provider Directory
Tax ID family
Cancer Care Associates Medical Group Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942299839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 N PROSPECT AVE",
            "address_2": "4TH FLOOR",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773040",
            "telephone_number": "310-750-3300",
            "fax_number": "310-750-3381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1360 W 6TH ST",
            "address_2": "STE #315",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323581",
            "telephone_number": "310-750-3300",
            "fax_number": "310-750-3381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANCER CARE ASSOCIATES MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CO OWNER PRESIDENT",
        "authorized_official_telephone_number": "310-750-3300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "FNP17913",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CS0850",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ28793Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.